Gout, with a section on ocular disease in the gouty

by Llewellyn J. Llewellyn

Evidence of Gout in the Eye.—When we inquire what is the evidence which justifies the belief that gout causes ocular disease we find little more than a traditional hypothesis inherited in a long line of succession from the Fathers of Medicine. Nevertheless the opinion that there is a connection is widespread, not only in Europe, but also in America.

In considering this relationship we cannot overlook the effects of the diathesis on other viscera. How in these is a diagnosis of gouty origin arrived at? It would appear that the assumption of an irregular form of gout is based upon the following observations:—

(i.) That it sometimes happens that an undoubted attack of articular gout aborts and is followed by symptoms referable to a grave visceral disorder, e.g., gout in the stomach (retrocedent gout);

(ii.) That sometimes the converse occurs, viz., that an attack of visceral disorder may suddenly be replaced by an acute articular manifestation;

(iii.) That such visceral derangements may alternate, not only with articular, but also with other, such as cutaneous, outbreaks;

(iv.) That eye disease has been known to wax and wane in unison with concurrent arthritic gouty manifestations;

(v.) That occasionally in gouty people an attack of iritis of sudden onset in the night has been followed by remission of the symptoms in the day[47];

(vi.) That visceral symptoms in the gouty are anomalous and inexplicable on any other basis;

(vii.) That the treatment usually advocated for gout has a favourable influence.

Deposition of Urates.—Two cases are recorded by Garrod in which there was a deposit of urates in the sclera. These instances do not appear to have been confirmed by other observers, and they may be regarded as exceptional cases, occurring, it should be noted, in the outer envelope of the eye. But though these tophaceous deposits may occur in the sclera and in the eyelid, they have never been known to invade the intrinsic structures, such as the iris or ocular media. The eye, in fact, is on all fours with the sites of urates elsewhere—deposition occurs in parts of relatively low vitality.